Psychologist explains which age group is most affected by trauma during war

Terrible things have been happening for weeks in the conflict between Hamas and Israel. How do you follow what’s happening in the Middle East?
Andreas Maercker: With great sympathy. I have been to Israel and Palestine on and off for the past 25 years. And because as a German I also have the background of the history of Nazi Germany with the Holocaust in mind. But I try to channel that. In the morning I look at the newspaper and in the evening I follow the news again. In the meantime, I’m trying not to consume media.

As with many other conflicts, children on both sides are affected. How do children cope when close family members, such as their parents, die?
In such a conflict, the public often focuses on the children who are particularly suffering. On the other hand, it is a lesson of psychotraumatology that children are often not as severely affected – psychologically and in the long term – as is the case with adolescents and adults. Children can process trauma relatively quickly if – and this is very important – their caregivers do not collapse. When someone’s caregivers suffer severely, it is the worst for children. Otherwise, children can sometimes cope with the death of family members better than other age groups.

Which age group is most affected by trauma?
On the one hand, people in the so-called sandwich position, who have downward responsibility for their children, but also upward responsibility for their parents. In the short term, these people do not experience much trauma, but in the long term they are the ones who suffer from many psychological and physical diseases and have a very difficult time to bear the fact that they had to go through a difficult phase with the consequences of a trauma.

And the second group?
These are the young people; they sometimes suffer enormously because their family members have been injured or killed in a conflict or war. In the teenage years, the trauma often hits very deep and has long-lasting consequences.

To what extent do children deal with traumatic experiences differently than adolescents and adults?
Children have a naive idea of ​​death. For example, they think that someone in the sky, in the clouds, is watching them. Or that this person will come back to life. This way of thinking takes children through terrible times, such as those currently in the Middle East. It is no coincidence that television images show children laughing and jumping among the rubble, both in Israel and Gaza. Young people and adults, on the other hand, often cannot switch to happy mode every now and then.

Do children have no trauma at all or much less?
Fewer. But one should not focus these findings solely on the Israeli-Gaza conflict; we see them everywhere. As representatives of clinical psychology and psychiatry, we have not yet succeeded in convincing the media that it is not children who suffer most in war.

At what point are you considered traumatized?
According to the latest definitions, one is considered traumatized if one experiences pronounced psychological reactions, both in the short and long term. Affected people may be in a state of paralysis for a short time, they may have a mental block and cannot control their crying and screaming. Long-term consequences include constant irritability and permanent anxiety.

Does the question of resilience play a role in the current war in the Middle East? What contributes to this?
Certainly. We know several factors that contribute to resilience. It only matters whether someone is involved in a horrific scenario such as war for professional reasons, for example as a soldier, police officer or paramedic. Another factor is the environment. If you have a close, social environment where you feel at home, that helps enormously. However, in individual cases it is difficult to predict who will be resilient and who will not.

This is not the first time that rockets have flown into the Gaza Strip. Have you ever become jaded as a resident?
This varies from person to person. The dullness as such usually lasts only a certain period, sometimes only a few days, and then one experiences another terrible event, again like the first, and experiences it as a horrific experience of violence. Boring is certainly not a permanent condition.

Can we talk about generational trauma in relation to the war in the Middle East?
We have a lot of evidence for the intergenerational transmission of trauma – including in the context of the Israeli-Palestinian conflict. For Israeli Jews, the traumas stem from the Holocaust persecution they experienced in Europe in the mid-20th century. Representatives of other generations of Jews therefore feel particularly threatened. The Palestinians, who have been pushed to the margins by the State of Israel since 1950 and placed in permanent refugee camps, experience a trauma that has also lasted for many generations. Also because more and more Palestinians were dying. This contributes to why hatred still exists today and why reconciliation is so terribly difficult.

Can children and adults still be treated after a certain level of trauma?
In short, for any type of trauma, even long-term, there is always a chance of success. Sometimes even psychotherapy is not enough. Moreover, with regard to the war in the Middle East, therapy does not always take place in an environment without danger. This constant threat also means that psychotherapy is unsuccessful in some cases.

Does it matter when psychotherapy starts?
There are two approaches. First of all, it concerns so-called emergency psychological care, which serves as prophylaxis and is very different from psychotherapy. This is a care measure that can also be carried out by other professionals trained in psychology. Even laypeople can be trained to provide this emergency psychological care. Psychotherapies, on the other hand, usually begin six months or even later after a traumatic event, for people who have suffered severe traumatic consequences. In most cases, only then are traumatized people willing to talk to a therapist. For the others, the aforementioned resilience plays a role. However, this never happens immediately, but only after several days, weeks or even months.

Can psychotherapeutic help currently be guaranteed in conflict areas in the Middle East?
This is possible in both countries, Israel and Palestine/Gaza. In Israel, mental health emergency response is quite well positioned due to the long-standing threat to the country. I was also approached by Israeli colleagues because they wanted to know what the latest diagnostic options were. An example is a triage, which asks about the stress level of individual people and then we look at who needs more intensive care and who may not need care at all.

And in Palestine/Gaza?
There is little care available there and the associated infrastructure may have been partially destroyed. But there were and are more doctors and psychologists trained in psychotraumatology in Palestine/Gaza than in other countries. Also because the threat has been going on for some time and because there was international support to establish a psychotraumatology department.

In a situation like the war in the Middle East, is there a point of resignation where people become so traumatized that they completely lose faith in the good?
The interesting thing is that both can happen. That you completely lose confidence in the good in people, but also that confidence in the good can arise. The extreme inner turmoil can lead to a realignment of the values ​​one has had in life so far.

You mentioned the topic of hate earlier. What role does hatred play in a conflict like the one in the Middle East?
Hatred plays a major role on two levels. On an individual level, it is a correlate of constantly thinking that hopefully nothing will happen. Anger and hatred can arise very easily; this can be observed in all forms of traumatization. Socially, hatred reinforces the other side’s political rejection, even leading to the desire for destruction. This form of hatred can be passed on from generation to generation.

As a person who has lost family members due to acts of war, for example, can you do anything other than stir up hatred?
That certainly happens. There are people who have lost a family member to crime or political violence and still contact the perpetrators. Anger and hatred are certainly becoming more common, but there is also talk of breaking the cycle of violence.

How can this be explained?
Due to personality factors, which can be very different. People are more or less good-natured, to take one example. But situational factors also play a role. For example, the support you receive at a traumatic moment.